T2N0M0期非尿路上皮膀胱癌三联疗法与根治性膀胱切除术的癌症特异性生存率

Cancer-Specific Survival of Trimodal Therapy Versus Radical Cystectomy in T2N0M0 Non-Urothelial Bladder Cancer.

作者信息

Longoni Mattia, Marmiroli Andrea, Falkenbach Fabian, Le Quynh Chi, Nicolazzini Michele, Catanzaro Calogero, Polverino Federico, Goyal Jordan A, Ferro Matteo, Graefen Markus, Chun Felix K H, Palumbo Carlotta, Schiavina Riccardo, Longo Nicola, Saad Fred, Shariat Shahrokh F, Moschini Marco, Gandaglia Giorgio, Montorsi Francesco, Briganti Alberto, Karakiewicz Pierre I

机构信息

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.

Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy.

出版信息

J Surg Oncol. 2025 Jul;132(1):235-242. doi: 10.1002/jso.70014. Epub 2025 Jun 13.

DOI:10.1002/jso.70014

PMID:40511689

Abstract

INTRODUCTION

We hypothesized that, within organ-confined (OC, T2N0M0) non-urothelial carcinoma of urinary bladder (non-UCUB) patients, trimodal therapy (TMT) use does not differ from radical cystectomy (RC) regarding cancer control outcomes.

METHODS

Within the SEER database (2004-2021), rates of TMT versus RC use in OC non-UCUB patients were calculated. Nearest-neighbor 1:1 propensity score matching (PSM) for age, sex, race/ethnicity, and histological subtype was applied. Cumulative incidence plots depicted 5-year cancer-specific (CSM) and other-cause mortality (OCM) rates. Multivariable competing risks regression (CRR) models were fitted. Sensitivity analyses were performed within squamous cell (SCC), neuroendocrine (NEC), and adenocarcinoma (ADK) and other histological subtypes.

RESULTS

Of 814 OC non-UCUB patients, 310 (38%) received TMT versus 504 (62%) RC. After PSM, 5-year CSM rate was 50% after TMT versus 29% after RC and TMT was associated with 2.1-fold higher CSM relative to RC (multivariable HR [mHR]: 2.1, p < 0.001). In sensitivity analyses within 229 (28%) SCC, TMT patients had higher 5-year CSM rates relative to their RC-counterparts (67% vs. 22%, mHR: 4.3, p < 0.001). Similarly, within 314 (39%) NEC, TMT patients had higher 5-year CSM rates relative to their RC-counterparts (mHR: 1.8, p < 0.001). Conversely, within 118 (28%) ADK and 153 (19%) other subtypes, CSM after TMT did not differ from CSM after RC (33% vs. 15%, mHR: 1.4 and 43% vs. 33%, mHR: 1.4; p = 0.4).

CONCLUSION

In OC non-UCUB patients TMT is associated with significantly higher CSM than RC. Most pronounced survival disadvantage was recorded within SCC and NEC patients.

摘要

引言

我们假设，在器官局限性（OC，T2N0M0）膀胱非尿路上皮癌（non-UCUB）患者中，三联疗法（TMT）在癌症控制效果方面与根治性膀胱切除术（RC）并无差异。

方法

在监测、流行病学和最终结果（SEER）数据库（2004 - 2021年）中，计算OC non-UCUB患者中TMT与RC的使用比例。对年龄、性别、种族/民族和组织学亚型进行1:1倾向评分匹配（PSM）的最近邻匹配。累积发病率图描绘了5年癌症特异性死亡率（CSM）和其他原因死亡率（OCM）。拟合多变量竞争风险回归（CRR）模型。在鳞状细胞癌（SCC）、神经内分泌癌（NEC）、腺癌（ADK）和其他组织学亚型中进行敏感性分析。

结果

814例OC non-UCUB患者中，310例（38%）接受了TMT，504例（62%）接受了RC。PSM后，TMT组5年CSM率为50%，RC组为29%，且TMT组CSM相对于RC组高2.1倍（多变量风险比[mHR]：2.1，p < 0.001）。在229例（28%）SCC的敏感性分析中，TMT患者的5年CSM率高于接受RC的对应患者（67%对22%，mHR：4.3，p < 0.001）。同样，在314例（39%）NEC中，TMT患者的5年CSM率高于接受RC的对应患者（mHR：1.8，p < 0.001）。相反，在118例（28%）ADK和153例（19%）其他亚型中，TMT后的CSM与RC后的CSM无差异（33%对15%，mHR：1.4；43%对33%，mHR：1.4；p = 0.4）。